Comparison of Tumor Volume Dependent Mean Diameter with the Longest Diameter and Tumor Volume in Assessing Axillary Lymph Nodes in Breast Cancer
JCPSP-JOURNAL OF THE COLLEGE OF PHYSICIANS AND SURGEONS PAKISTAN
Authors: Kubat, Mehmet; Karabulut, Zulfikar
Abstract
Objective: To investigate the effectiveness of tumor volume dependent mean diameter (Rmax) in determining axillary lymph node metastasis positivity instead of the largest diameter (Dmax) in breast cancer. Study Design: Descriptive study. Place and Duration of Study: Department of General Surgery, Ankara Training and Reseach Hospital, Turkey, from January 2009 to December 2018. Methodology: Patients with breast cancer, who underwent modified radical mastectomy and lumpectomy and axillary lymph node dissection due to invasive carcinoma, included in this study. Approximate vTm was calculated from the obtained tumor specimen dimensions using ellipsoid volume formula. From the sphere volume formula, Rmax, which gives the same vim value, was reversely calculated. Efficacy and usability of Rmax value were evaluated on nomograms that are available online; and are used most frequently owing to its ease of use. Results: In 305 patients, mean Dmax was 3.4 +/- 1.8 cm, mean vTm was 17.9 +/- 35.9 cm(3), and mean Rmax was 2.6 +/- 1.4 cm. For the distinction of ALNM positive and negative patients, Dmax significant [Area Under Curve (AUC) 0.709], Rmax significant [AUC 0.748] and vTm significant [AUC 0.748] efficacy was considered. Conclusion: When the relationships of Dmax and vTm with ALNM were compared in breast cancer cases, the efficacy of vTm is higher. It was found that vTm and Rmax can be used instead of Dmax. The relation of Rmax parameter with ALNM was found to be higher. When Rmax was used in nomogram samples, which are currently used in predicting ALNM positivity, it increased nomogram efficacy.
Correlation between fractional anisotropy changes in the targeted ventral intermediate nucleus and clinical outcome after transcranial MR-guided focused ultrasound thalamotomy for essential tremor: results of a pilot study
JOURNAL OF NEUROSURGERY
Authors: Hori, Hiroki; Yamaguchi, Toshio; Konishi, Yoshiyuki; Taira, Takaomi; Muragaki, Yoshihiro
Abstract
OBJECTIVE This study evaluated changes of fractional anisotropy (FA) in the ventral intermediate nucleus (VIM) of the thalamus after transcranial MR-guided focused ultrasound ( TcMRgFUS) thalamotomy and their associations with clinical outcome. METHODS Clinical and radiological data of 12 patients with medically refractory essential tremor (mean age 76.5 years) who underwent TcMRgFUS thalamotomy with VIM targeting were analyzed retrospectively. The Clinical Rating Scale for Tremor (CRST) score was calculated before and at 1 year after treatment. Measurements of the relative FA (rFA) values, defined as ratio of the FA value in the targeted VIM to the FA value in the contralateral VIM, were performed before thalamotomy, and 1 day and 1 year thereafter. RESULTS TcMRgFUS thalamotomy was well tolerated and no long-term complications were noted. At 1-year follow-up, 8 patients demonstrated relief of tremor (improvement group), whereas in 4 others persistent tremor was noted (recurrence group). In the entire cohort, mean rFA values in the targeted VIM before treatment, and at 1 day and 1 year after treatment, were 1.12 +/- 0.15, 0.44 +/- 0.13, and 0.82 +/- 0.22, respectively (p < 0.001). rFA values were consistently higher in the recurrence group compared with the improvement group, and the difference reached statistical significance at 1 day (p < 0.05) and 1 year (p < 0.01) after treatment. There was a statistically significant (p < 0.01) positive correlation between rFA values in the targeted VIM at 1 day after thalamotomy and CRST score at 1 year after treatment. Receiver operating characteristic curve analysis revealed that the optimal cutoff value of rFA at 1 day after thalamotomy for prediction of symptomatic improvement at 1-year follow-up is 0.54. CONCLUSIONS TcMRgFUS thalamotomy results in significant decrease of rFA in the targeted VIM, at both 1 day and 1 year after treatment. Relative FA values at 1 day after treatment showed significant correlation with CRST score at 1-year follow-up. Therefore, FA may be considered a possible imaging biomarker for early prediction of clinical outcome after TcMRgFUS thalamotomy for essential tremor.